April 17,2017

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Aaron Fobes, Julia Lawless (202)224-4515

New Report Highlights Issues with Medicaid Integrity

New Data from Non-Partisan Watchdog Shows Need for Updates at the State Level
WASHINGTON – New data from a Government Accountability Office (GAO) report issued today illustrates the need for improvements to the Centers for Medicare & Medicaid Services’ (CMS) oversight and support of states’ Medicaid program integrity efforts. As part of this oversight effort, CMS reviews areas at high risk for improper payments at the state level including provider enrollment, screening and personal care services.

“At the most basic level, patients should rest assured that their private information is protected from fraud and abuse,” Hatch said. “That’s why it is imperative that CMS takes the necessary precautions to protect against the high risk of provider improper payments. The data from this report reveals that demand for these crucial Medicaid services require additional resources than are currently available and highlights the need for better oversight and stronger support for integrity efforts at the state level. While I’m pleased that CMS has taken steps to reform some of its most important programs, the agency must continue to address this issue, along with others, to curb waste and ensure patients are receiving proper care.”

GAO’s Medicaid integrity report found that while the Medicaid Integrity Institute (MII) is an important training resource, state demand exceeds the institute’s capacity to perform proper oversight.

Additional findings of the report include:

•    In 2016, CMS conducted Medicaid integrity reviews in 40 states.
•    The total time for the review process has dropped recent years, resulting in a reduction in review time from 489 days in fiscal year 2014 to 278 days in fiscal year 2015.
•    CMS lacks a systematic approach for collecting and distributing favorable state program integrity practices to states.

Click here to read the GAO report.